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Permit CITY TIGARD MECHANICAL PERMIT DEVELOPMENT SERVICES PERMIT #: MEC2003 -00601 4114' 131 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 10/15/03 PARCEL: 2S111DB-12801 SITE ADDRESS: 09400 SW LAKE SIDE DR SUBDIVISION: SUMMERFIELD NO.12 ZONING: R -7 BLOCK: LOT: JURISDICTION: TIG CLASS OF WORK: ALT FLOOR FURN: EVAP COOLERS: TYPE OF USE: SF UNIT HEATERS: VENT FANS: OCCUPANCY GRP: R3 VENTS W/O APPL: VENT SYSTEMS: STORIES: BOILERS /COMPRESSORS HOODS: FUEL TYPES 0 - 3 HP: DOMES. INCIN: LPG 3 - 15 HP: COMML. INCIN: MAX INPUT: BTU 15 - 30 HP: FIRE DAMPERS ?: 30 - 50 HP REPAIR UNITS: GAS PRESSURE: 50 + HP: WOODSTOVES: FURN < 100K BTU: 1 AIR HANDLING UNITS CLO DRYERS: FURN > =100K BTU: <= 10000 cfm: OTHER UNITS: > 10000 cfm: GAS OUTLETS: Remarks: Replace gas furnace. Owner: FEES ALLEN, MARJORIE E TRUSTEE + Description Date Amount ALLEN, MARJORIE E 9400 SW LAKESIDE DR [MECH] Permit Fee 10/15/03 $72.50 TIGARD, OR 97224 [TAX] 8% StateTax 10/15/03 $5.80 Phone: 503 684 - 3063 Total $78.30 Contractor: COLUMBIA HEATING + COOLING INC P.O. BOX 230397 8900 SW BURNHAM #E1110 REQUIRED INSPECTIONS TIGARD, OR 97223 Phone: 503 Heating Unt Insp Final Inspection Reg #: LIC 76359 This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Ore. Specialty Codes and all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted in the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -00 Issued By: IA � _ %� 1, _ / Permittee Signature:/ Call (503) 639 -4175 by 7:00 P.M. for inspections needed the next business day i • A Mechanical Application = ' .- __ , . ru..r� , Datereceived0 / S G Permit no.: ll JO '� ,D ,11.1 City of Tigard Re� ProjecUappl. no.: Expire date: City of Tigard AddreSt: 13125 SW Hall Blvd, Td, 0I 2TE® Phone: (503) 639 -4171 OC d/C Date issued: By: j Receipt no.: Fax: (503) 598 -1960 1 ?40 Case file no.: Payment type: Land use approval: _ Au OFT� J Building permit no. / C IN . QA l RD TVIT OF PERMIT • ,; - ❑ 1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi- family ❑ Tenant improvement ❑ New const ruction ` 4/ Addition/alteration/replacement ❑ Other: ., , r , JOB SITE INFORMATION • COMMERCIAL VALUATION SCHEDULE r „- Job address: ?Lfo d c_5(.4/ L a �,Co J Indicate equipment quantities in boxes below. Indicate the dollar Bldg. no.: I Suite no.: value of all mechanical materials, equipment, labor, overhead, Tax map /tax lot/account no.: profit. Value $ . Lot: 'Block: ' Subdivision: *See checklist for important application information and Project name: jurisdiction's fee schedule for residential permit fee. City /county: .--::--- • ZIP: I & 21AMII.V DWELLING PERMIT iLl' SCllEDULE ' Description and loca ion of work on premises: AND ('0111MI RI('ALIINDUSTRIAL F.Q1111'MENTSCIII DULE / " /r,"¢� .-• , . .... Fee(ea.) Total Est. date of completion /inspection: Description Qty. Res. only Res. only Tenant improvement or change of use: HVAC: Is existing space heated or conditioned? ❑ Yes ❑ No Air handling unit CFM Air conditioning (site plan required) Is existing space insulated? ❑ Yes ❑ No Alteration of existing HVAC system ' ' ' MECHANICAL CONTRACTOR .- Boiler compressors Business name: State boiler permit no.: I■ ' HP Tons BTU /H ■ Address: 0 0 1 ox ,2 3 03 " '7 Fire /smoke dampers /duct smoke detec tors City: State: i• ZIP: - Heat pump (site plan required) -- Phone: entrn= E -mail: Instal replacefurnac .urnerL� % :TU /H -- CCB no.: �� Including ductwork/vent liner ❑ Yes o 9 Installlreplace/relocate heaters - suspended, - City /metro lic. no.: l a 7 a wall, or floor mounted Name (please print): �� GA pc_ o i3 c..L Vent or appliance other than furnace " " CONTACT PERSON Refrigera : P Absorption units BTU /H Name: Pi9M QA /b y / DHN ©QUgAeaaiy Chillers HP Address: J Compressors HP !Environmental exhaust and ventilation: ■ City: ' State: ' ZIP: Appliance vent Phone: a 0 Fax:5 1 , i E-mail: Dryer exhaust O��rI�F� oo • s, Type II res. kitchen/hazmat hood fire suppression system Name: /27/16 Exhaust fan with single duct (bath fans) Mailing address: d j 1,f) 6 _ d ,�_ L / Exhausts stem start from heatin • or AC e p p • g an. .1 1 ut on up to • out ets City: i �_ ZIP: Type: LPG NG Oil • Phone: „ p6,3 Fax: E-mail: Fuel • F 1 .l ung each additional over 4 outlets ;«: ' ' ENGINEER ` b - ' rocess p p .g (schematic required) Name: Number of outlets Other listed appliance or equipment: Address: Decorative fireplace City: . State: ZIP: Insert - type Phone: I Fax: ( E -mail: Woodstove/pellet stove Other: Applicant's signature: ( Date: /0 2 D Stier: Name (print): ,A ,ni-/ Li / ' Not all jurisdictions accept credit cards, please call jurisdiction for more information Permit fee $ - 1,9 ,U -D Visa —O "MasterCard Notice: This petmit application Minimum $ Credit card number: / if a p ermit is not obt / Plan review (at %) $ Expires within 180 days after it has been State surcharge (8 %) .... $ ,..5.7-____/ 3 ) l) Name of cardholder as shown on credit card accepted as complete. $ TOTAL $ Cardholder signature Amount i 440-4617 (fi00/COM) CITY OF TIGARD 24 -Hour BUILDING Inspection Line: (503) 639 -4175 INSPECTION`I'STVISION Busine.s Lime: (503) 639 -4171 MST BUP Received 10 Fi Date Requested ( /z AM PM BUP Location d R 4 0r) Lct ad e - Suite Co 3 D 067 0 Contact Person Pawl 0 d d, Ph ( ) Z.0 2/1 - 2 70V PLM Contractor _ re) I u (NI b t 4: 1_ q Ph ( ) SWR BUILDING , Tenant/Owner Footing • ELC Foundation Access: Ftg Drain - ELR Crawl Drain Slab Inspection Notes: ityli tA/ v L L, j yL SIT Post & Beam Shear Anchors ..<6_3 Q 5 '574 e Z' Ext Sheath /Shear Int Sheath/Shear Framing Insulation Drywall Nailing Firewall C r Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Other: �, _„) ,, Final I G " PASS PART FAIL / PLUMBING` Post & Beam Under Slab Rough -In Water Service Sanitary Sewer Rain Drains Catch Basin / Manhole Storm Drain Shower Pan Other: Final PASS PART FAIL MECHANICAL Post & Beam Rough -In Gas Line . Smnk� Dampers PART FAIL EL ICA L Service Rough -In UG /Slab Low Voltage Fire Alarm Final El Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. PASS PART FAIL SITE 0 Please call for reinspection RE: 0 Unable to inspect - no access — - Fire Supply Line ADA Approach /Sidewalk Date _4�Z Z L Inspector • ti, c 1..., . Ext Other: Final DO NOT REMOVE this inspection record from the job site. PASS PART FAIL